Medicaid
This week we’ll look into another complex insurance system: Medicaid. The focus will be on Texas Medicaid as the nuances can vary from state to state. The basic idea for all state Medicaid systems is the same, and qualification is based on Modified Adjusted Gross Income (MAGI). MAGI is a person’s Adjusted Gross Income (taxable income), but with untaxable sources added back in, such as student loan interest deductions, IRA deductions, and passive income or losses. There are many other examples, and we could definitely become bogged down in definitions, let alone how to qualify for this insurance.
Medicaid, in Texas, covers many children, pregnant persons, and persons with disabilities. Because Texas has not expanded coverage to adults, the only way to qualify as an adult (after meeting income adjustments), is to be pregnant, caring for a child 18 years old or younger, have a disability or be caring for a family member with a disability, or be over 65 years old. The annual maximum income, before taxes, for a household of 1 person is approximately $25,500 and increases by about $9000 for every additional person in the household.
To apply this to an older adult in Texas, that person must be 65 years old or older and have a MAGI of $25,500 or less. If that person is married or has a dependent in the house, they must have a MAGI of $34,492. The benefit of qualifying for Medicaid at this stage in life is that many screening tests are covered, as are lab tests, imaging studies, and physician services. Medicaid is also responsible for the payment of nursing home services for long term care. Remember, Medicare part A pays for nursing home services for rehabilitation. Many people will qualify for both Medicare and Medicaid, and this “dual-eligible” situation helps many people have access to services they may not have had in the past as Medicaid can assist with paying Medicare Part B premiums.
As an experiment, I called the Texas Medicaid hotline, which was incredibly useless and advised me to call 211. After calling 211, I was finally, but indirectly, steered to the website YourTexasBenefits.com to be able to start an application for Medicaid. Notably, if a person uses google or bing to search for a way to apply for Medicaid, the website YourTexasBenefits is the 4th hit, and its description does not make it clear that it is the place to apply for Medicaid. I should also note that I have access to the internet and a computer, something many older adults that qualify for Medicaid may not have on a regular basis. Obviously the whole system is incredibly complicated and difficult to navigate as a patient, and right now it seems a dream that everyone in the United States has equal and easy access to healthcare.
Key Points:
Medicaid is a federal and state insurance program, requirements for qualification vary by state
Adults over 65 in Texas qualify if they meet certain income requirements
Navigating the health system can be incredibly complex, especially for seniors
